How India's lockdown has affected mental health

India’s public landscape has transformed dramatically over the last couple of months, with the most prolonged lockdown that the present generation can remember. Declared on March 24, 2020, the lockdown ensured that hundreds of millions of people were effectively confined to home, except when they ventured out, armed with a self-attested affidavit, to stock up on essentials.

While this may have been effective in helping to curb the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in India, it has not, perhaps, been conducive to the emotional and mental health of some groups.

A recent study published on the preprint server medRxiv* in May 2020 concludes that select groups might have suffered emotionally, and outlines measures to alleviate such potential harm.

What Areas Did the Lockdown Impact?

The lockdown applied to three main areas: physical movement out of the home, social distancing when outside the home, and restricted availability of most public services while sparing essential services. There was a sudden and drastic alteration in the daily routine, with many millions stranded in boarding houses and rental apartments, without work and far from home.

Academic work ground to a halt, with auxiliary staff like cleaners, security guards and gardeners suddenly being thrown out of their contractual work. Earlier studies have shown that this sudden loss of employment, along with financial stress or even distress, could enhance the psychological impact on the working community, shown by symptoms of increased aggressiveness and post-traumatic stress.

However, the impact of the lockdown is likely to be heaviest on those who are alone, poor, already psychologically burdened, or out of the mainstream at baseline.

One such group is the sexual minorities, which are already excluded from most mainstream Indian communities. Such individuals may quite well be unable to visit others in their community, which put their sex lives on hold and encouraged online pornography as a means of coping with their sexual needs. These disruptions in sexual lives, in addition to the on-going stress due to the lockdown, could also persuade individuals to (mis)use pornography for coping, which could further lead to depressive symptoms.

Another more needy group is the community of old and sick people, often without immediate family caregivers in the vicinity. They are known to have a higher risk of acquiring the infection. Those who are exposed to potential sources of infection on a daily basis are even more likely to be stressed about the possibility of not only becoming infected but carrying the virus home to their families and friends.

Depression and Anxiety in the Lockdown in India and Abroad

Studies from Wuhan and Australia showed high levels of depression among frontline healthcare workers and people in communities with high infection rates. Such anticipatory stress and anxiety, along with loneliness, could not only affect mental health but lead to a decline in lifestyle quality and, ultimately, one’s health choices. Depression is a known risk factor for sleep disorders and eating disorders.

However, India also offers, by virtue of its social structure, a variety of personal and social resources that help cope with such crises. Family is one such vital resource, and being in close touch with relatives, in real life or virtually via social media or the Internet, alleviates stress considerably.

In fact, the extended time spent with family members, free of the stress of normal working and school days, may well have strengthened family bonds and restored balance to life, leading to an actual improvement in the quality of life during the lockdown.

Of course, the opposite situation prevails with those who do not get along well with their families, inducing more conflict and promoting poorer outcomes during this period.

In addition, there are many factors which operate at an individual level, such as the kind of job (menial, farming, semi-skilled, skilled, office workers and managers, and professional workers), the availability of material resources if required, and the psychological make-up of the individual (resilience, coping, and optimism).

What Prompted the Current Study?

Few studies have explored this aspect of the lockdown in the Indian context, and most of the existing research fails to be inclusive in scope.

The current study is meant to unravel the links between social factors like sexual orientation, type of family relationship, and residence in areas that have a high infection rate, and adverse mental health outcomes.

The investigators also examined the processes that determine how and when sleeping and eating habits are intertwined with anxiety and depressive symptoms. Individual resilience and coping strategies were also explored. Finally, they looked into the possibility of empathic changes in the way people view the world, which could be a valuable mental resource helping to increase overall wellbeing and quality of life.

How Was the Study Conducted?

The researchers first did two qualitative in-depth interviews to understand the context better before finally framing their research questions for the definitive online quantitative survey. They also conducted 14 qualitative interviews from May 10 to May 17, 2020. The subjects were self-selected by broad social media invitations.

The online survey spanned May 9 to May 15, 2020, using an anonymous Google form via social media. They used items like anxiety, depressive symptoms, symptoms of internet addiction, pornography addiction, experiences of hostility, changes in food and sleep habits, social empathy and relationship quality, to construct the overall picture of social and psychological experience during the lockdown period.

The survey included 282 Indian adults, three-fourth of whom were 30 years or younger. About 60% said they were male and 77% heterosexual. Most (88%) were educated beyond the 12th standard. About 81% were urban residents.

What Was the Impact on the Study Sample?

The analysis showed that mean anxiety (Generalized Anxiety Disorder, GAD) scores were higher for sexual minorities than for heterosexuals, high-risk groups vs. low-risk groups, and people with a history of depression/loneliness. GAD scores were lower for singles than for those in relationships with the opposite sex and insignificantly lower for those in same-sex relationships compared to heterosexual relationships.

There was no link between residence in a high case-count area or state and anxiety symptoms.

Depressive symptoms were independently associated with a history of loneliness and depression, but not with sexual orientation, residence in a high-risk state, and being in a high-risk group. They were linked to higher Internet addiction symptoms independently.

Pornography addiction was higher in those with a history of depression or loneliness, in sexual minorities than in heterosexuals, in those at high-risk compared to low-risk groups, and in same-sex relationship partners than in others. Sexual minority participants also reported a greater frequency of masturbation than heterosexuals.

As expected, the presence of depressive and anxiety symptoms was linked to a higher chance of self-reported sleep disorder and changes in food patterns.

People who called their family members more during the lockdown than in the same period six months earlier, and those who shared their vulnerabilities with their loved ones, were more likely to have social empathy and better social relationships.

Lockdown-Related Mental Stress in India

The researchers feel that sexual minorities are likely to experience “unique and additional stressors related to their minority identity, which could combine with other stressors to impact psychological wellbeing,” as a result of the lockdown. This situation could also revive memories of old traumas in some people. The use of porn and the Internet to cope with the dullness and anxiety of these days could turn to addiction, leaving behind a permanent adverse impact even after the lockdown is over.

However, the qualitative part of the study reveals that resilience and healthy coping strategies helped even high-risk individuals to stay positive, view the lockdown as a good time to ruminate on their individual and social identity, and take steps to improve their relationships with their families.

It is clear that the study sample is extremely limited, non-inclusive, and non-representative of the Indian population at large. Rather, this was a group of well-educated young Indians, with almost half of the qualitative interviews, surprisingly, being with individuals from a sexual minority.

The researchers conclude, “To our knowledge, this is the first study to look at the differential psychological impact of the lockdown across different social groups in India. Our study also highlighted a few positive aspects of the lockdown, underscoring the increase in social empathy and strengthened social bonds among Indian adults.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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